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Underweight patients are more likely to die after emergency general surgery than patients who are normal weight or overweight, and patients who are both frail and underweight face an even higher risk of death and other adverse clinical outcomes, according to new research findings.

The study drew on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database and included more than 334,000 adults who had emergency general surgery between 2019 and 2024.

The research was presented at the American College of Surgeons (ACS) Clinical Congress 2026 in Washington, Sept. 26–29.

"Our study shows that patients who are both underweight and frail have the worst outcomes. We also saw that frailty reduces the positive impact of the obesity paradox—the finding that patients who are overweight, but not at the extremes of obesity, tend to have better outcomes. That protective effect is lost if a patient is frail," said lead study author Ellen Cohn, MD, MPH, a third-year general surgery resident at the University of Chicago.

"What we take away from this study is that risk can be mitigated. We can make real-world changes to body mass index (BMI), and physical therapy can reduce frailty. What is unique about our study is that we were able to look at the impact of BMI and frailty together," she said.

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